NCT06969521

Online Rotating Delivery of Perception/Production Enhanced Treatment for Rhotics

Online Assessment and Enhancement of Auditory Perception for Speech Sound Errors: Online Rotating Delivery of Perception/Production Enhanced Treatment for Rhotics

• Status: Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 60 (estimated)
• Sponsor: Montclair State University · Academic / Other
• Sex: All
• Age: 8 Years – 17 Years
• Healthy volunteers: Not accepted

Summary

The goal of this clinical trial is to determine whether perceptual training enhances speech perception and production outcomes in children with Residual Speech Sound Disorders (RSSD). The main questions it aims to answer are: Does pre-treatment speech production accuracy predict treatment response? Does perceptual acuity influence the effectiveness of perception-first versus production-first interventions? Researchers will compare TAU+Perception-first and TAU-first treatment conditions to see if the order of intervention affects speech improvement outcomes, particularly based on participants' initial perception and production accuracy. Participants will: Complete pre-treatment evaluations to assess /r/ production and speech perception. Be grouped into high or low production and perception accuracy categories based on established thresholds. Be randomly assigned (using a blocked randomization procedure) to one of two treatment arms via telepractice. Participate in the assigned treatment condition designed to target speech sound accuracy. Randomization is stratified to ensure treatment groups are balanced based on pre-treatment severity in both the perception and production domains.

Detailed description

Children with RSSD may vary in pre-treatment speech production severity, and the extent to which they can approximate /r/ may be an important indicator of subsequent treatment response. In addition, perceptual acuity may influence how participants respond to perception and/or production treatment. Therefore, a blocked randomization procedure will be used to protect against a situation where treatment groups are unbalanced with respect to pre-treatment severity in either the perception or production domain. Based on the treating clinicians' perceptual ratings of participants' performance in /r/ word probes administered in the pre-treatment evaluation phase, participants will be categorized as High Accuracy (\>10% accuracy) or Low Accuracy (\<=10% accuracy), a cutoff determined from pre-treatment baseline data aggregated over 11 studies previously conducted by our team. The investigators will henceforth refer to these groups as "production accuracy groups." In addition, the investigators will use the criteria adopted in the previous funding cycle to classify participants into high or low perception groups (henceforth, "perception accuracy groups"). Participants will be randomized to the TAU(Treatment as Usual) +Perception-first or TAU-first condition via telepractice with stratification on both perception and production accuracy group. Randomization will be supervised by statistician J. Hill at the NYU site. The investigators will use the following approach, adopted successfully for the RCT in the previous funding cycle: (1) Participants will be randomized after providing informed consent, meeting eligibility requirements, and completing the tasks and clinician-rated baselines that determine response group (High, Low). (2) For each perception accuracy group, the statistician will develop 2 batches of 10 concealed envelopes for assignment, one for high production accuracy participants and one for low production accuracy participants. Each will contain 10 participant assignments in random order: 5 TAU+ Perception-first, 5 TAU-first. (3) The investigators cannot fully predict the exact proportion of participants with high versus low production accuracy in each category of perceptual accuracy, so it is possible that the investigators will encounter significantly more in one group than the other. Thus, once the investigators have recruited the first 10 participants for one subgroup (e.g., Low Perceptual Accuracy, Low Production Accuracy), another batch of 10 envelopes will be generated to allocate the next 10 children recruited in that subgroup.

Conditions

• Speech Sound Disorder

Interventions

Type	Name	Description
BEHAVIORAL	Visual acoustic biofeedback: ORDER	In visual-acoustic biofeedback treatment, elements of traditional articulation treatment are used, including auditory models, verbal descriptions of correct articulator placement, cues for repetitive motor practice via images and diagrams of the vocal tract as visual aids. These strategies are supplemented with a dynamic display of the speech signal in the form of the real-time LPC (Linear Predictive Coding) spectrum (Sona-Match module of PENTAX Sona- Speech software). Because correct vs incorrect productions of /r/ contrast acoustically in the frequency of the third formant (F3), participants will be cued to make their real-time LPC spectrum match a visual target characterized by a low F3 frequency. They will be encouraged to attend to the visual display while adjusting the placement of their articulators and observing how those adjustments impact F3. Knowledge of performance feedback will typically involve reference to the location of the third peak on the visual display.
BEHAVIORAL	Perception Training: ORDER	Description: Perceptual training involves self-paced presentation of auditory stimuli via a computerized software program (Gorilla). Stimuli are organized into three separate tasks. In tasks 1 and 3, which train category goodness judgment, participants will hear 75 naturally produced speech tokens containing /r/ from various speakers, with a balance of correct and incorrect productions. They will classify each /r/ as correct or incorrect and receive feedback on the accuracy of their classification. Tasks 1 and 3 differ in that task 1 will feature a subset of items designed to provide focused practice on a specific context (e.g., initial /r/ as in red; /r/ as syllable nucleus as in sir), with increasing difficulty over time, whereas task 3 will feature randomly selected items representing all contexts and difficulty levels. In task 2, participants will hear 75 items drawn from the synthetic rake-wake continuum used in the identification task administered at baseline, but they will recei

Timeline

• Start date: 2025-05-10
• Primary completion: 2027-07-01
• Completion: 2027-07-01
• First posted: 2025-05-14
• Last updated: 2025-05-29

Locations

1 site across 1 country: United States